California Doctors' Group Pushes Full Coverage for Audio-Only Telehealth

California’s largest medical association is challenging Governor Gavin Newsom’s plan to set Medicaid reimbursement for audio-only telehealth at 65 percent, saying providers should be reimbursed at the same rate as for in-person care.

In a press release issued this week, the California Medical Association said it was “disheartened” by Newsom’s plan to reimburse for audio-only services at less than in-person rates for members of the state’s Medi-Cal program. The provision is included in Newsom’s proposed 2021-2022 budget.

“CMA believes it is critical to retain this important tool in reducing health care disparities for Medi-Cal beneficiaries, and is working to oppose this policy,” the organization, which represent some 50,000 physicians, said.

The debate mirrors arguments seen across the country as states and the federal government look to set long-term telehealth policy. And it focuses not only on payment parity for the telehealth platform, but whether providers should even be using the telephone to deliver healthcare.

With states and the federal government relaxing telehealth coverage and access rules during the coronavirus pandemic, many providers are using the telephone or telehealth platform that doesn’t include video. Those who support the platform say it allows providers to connect with patients who can’t afford or access audio-visual telemedicine technology, including rural and remote residents and the poor. It’s also much less of a burden on providers who are looking for quick and easy ways to communicate with patients on healthcare issues.

Opponents, meanwhile, have argued that the platform doesn’t support the doctor-patient relationship and isn’t safe and secure.

While most of the emergency measures will end with the COVID-19 public health emergency, some states have moved to make coverage permanent for audio-only telehealth, and in most cases that coverage will be equal to in-person reimbursement. Congress is also facing calls to extend coverage for the modality in certain situations, such as telemental health, and with strict rules over how the platform can and can’t be used.

In California, meanwhile, the CMS says it’s worried the providers will move away from audio-only telehealth if they’re not paid the same as for in-person care. The 65 percent rate, they said “amount(s) to, essentially a rate cut to physicians providing remote health care for Medi-Cal patients.”

“Overwhelmingly, Medi-Cal patients opt to utilize audio-only telehealth over audio-visual telehealth,” the organization said. “This could be due to a lack of good broadband connectivity, a need to take those telehealth visits on their mobile phones that have data limits, or for privacy reasons. Whatever the reasons, it makes little sense to eliminate an option for access to care, for those individuals who already lack it the most, further exacerbating existing inequities.”

“Under the Governor’s proposed telehealth policy, the only Californians who will be able to readily utilize telehealth are those with access to fast broadband, sufficient technology and commercial health coverage,” the group added.

As an alternative to Newsom’s plan, the CMA is part of a broad coalition of providers and other groups supporting AB 32. The bill, currently in committee, would, among other things, make the emergency telehealth measures permanent, allow providers – including community health centers and rural clinics - to use other modalities like audio-only telehealth, and establish payment parity for those services.

“If AB 32 passes, it will be a critical component of California’s telehealth policy infrastructure and would help pave the way for future health care innovation and advancement,” the CMA said.